Smoking is the leading cause of preventable mortality in United States, accounting for approximately 435,000 deaths each year in the United States. Most smokers make multiple attempts to quit smoking, but only 2-3% succeed each year. This proposal builds on a successful CDC-funded study "Financial incentives for smoking cessation" which is a 2-arm randomized control trial (RCT) of financial incentives for smoking cessation among employees at General Electric (GE) worksites throughout the United States. Eligible smokers were randomized to receive either usual care (information about local community-based smoking cessation resources) or usual care plus a package of financial incentives that includes $100 for completion of a community-based tobacco cessation program, $250 for tobacco cessation within the first 6 months following enrollment, and $400 for continuous tobacco cessation for the following 6 months (biochemically confirmed). We have found highly significant differences in smoking cessation program completion (9.6% vs. 0.9%, p<0.0001) and smoking cessation in the first 6 months (23.4% vs. 13.6%, p=0.0002). The current proposal has 3 Specific Aims: 1. To evaluate the public health impact of this program and the perceived barriers and facilitators of success, using the RE-AIM framework; 2. To examine the business case for adoption of this program based on within-trial data on cost- effectiveness as well as projections from the literature; 3. To assess the attitudes, information needs, and organizational factors that might impede or facilitate adoption of this program among corporate medical directors (CMOs) of large employers or insurers; The first aim will be achieved through a detailed process evaluation, which will involve focus groups of GE employees; interviews of local health champions at the largest worksites and those worksites most and least successful in recruiting; and careful assessment of the data from our RCT. The second aim will be achieved through a rigorous cost-effectiveness analysis in which we will examine the "business case" for this incentives program using both trial data at 12 months (final incentive payment) and 18 months (after incentive payments have ceased). The third aim will be achieved through structured interviews with the CMOs of the nation's largest employers and insurers to examine their level of interest and potential barriers to implementation of this intervention. We will be assisted in setting up these interviews by members of our Advisory Board, which includes the Chief of Health Benefits worldwide for GE, Bob Galvin, and the CMO of Aetna, Troy Brennan. Careful evaluation of our financial incentives intervention and its potential external validity will be an important next step to realizing the potential for this approach to substantially reduce the economic and health burden of smoking-related disease and disability among a large portion of the American population. [unreadable] [unreadable] [unreadable] [unreadable]